Microbiological characterization of neuropathic diabetic foot infection: a retrospective study at a Portuguese tertiary hospital.

Diabetic foot infection imposes a significant burden and is the major cause of nontraumatic limb amputation. Adequate patient management with effective antibiotic therapy is crucial.This retrospective cohort study aimed to characterize the microbiology and resistance patterns of moderate to severe neuropathic diabetic foot infection in patients hospitalized at a tertiary referral hospital between January 2020 and June 2023. Deep tissue specimens from ulcers were collected for culture.Sixty inpatients were included (62% male, mean age 59.1 ± 11.5 years). Osteomyelitis was present in 90% of the patients. Among 102 microorganisms (average of 1.91 ± 1.25 pathogens per patient), 60.8% were gram-positive bacteria, 31.4% were gram-negative, 3.92% were anaerobic bacteria, and 3.92% were fungi. Staphylococcus aureus (19%) and Enterococcus faecium (17%) were the most common. Pseudomonas aeruginosa (8%) and bacteria of the Enterobacterales family (24%) accounted for all the isolated gram-negative bacteria. Sixteen percent of Staphylococcus aureus and 67% of coagulase-negative Staphylococci were resistant to methicillin. Resistance to ampicillin was found in 11% of Enterococci. All Pseudomonas aeruginosa isolates were sensitive to piperacillin-tazobactam, ceftazidime, or cefepime. Among the Enterobacterales, resistance rates were 35% for piperacillin-tazobactam, 38% for ceftazidime, 21% for cefepime, and 13% for carbapenems.Although the prevalence of methicillin-resistant staphylococci was lower than that in other studies, carbapenem resistance among gram-negative bacteria warrants attention. This study highlights the importance of understanding local epidemiology for effective diabetic foot infection management and resistance mitigation.

Assessment of quality of life, psychological aspects, and sexual function of women with endometriosis according to pain and infertility: a cross sectional study.

PURPOSE: To evaluate the quality of life, sexual function, anxiety, and depression of women with endometriosis according to pain symptoms and infertility. METHODS: This cross-sectional multicenter study included 229 women with endometriosis followed up at a tertiary hospital in Campinas, a tertiary hospital in São Paulo, and a reproductive medicine clinic in Campinas from 2018 to 2021. The women were divided into four groups according to the presence of pain symptoms and infertility. The Endometriosis Health Profile Questionnaire, Female Sexual Function Index, Beck Depression Inventory, and Beck Anxiety Index were applied to assess quality of life, sexual function, depression, and anxiety of women with endometriosis. RESULTS: The women were grouped as follows: group 1 (45 women without infertility and without pain), group 2 (73 women without infertility and with pain), group 3 (49 women with infertility and without pain), and group 4 (62 women with infertility and pain). Of the women with infertility, the majority had primary infertility. Most women had deep endometriosis (p = 0.608). Women with pain had higher anxiety and depression scores and worse quality of life than women without pain (p < 0.001). Regarding sexual function, all the groups were at risk for sexual dysfunction (p = 0.671). The group of women with pain and infertility have worse anxiety scores (25.31 ± 15.96) and depression (18.81 ± 11.16) than the other groups. CONCLUSION: Pain symptoms worsen anxiety, depression, and quality of life of women with endometriosis and when associated with infertility, greater impairment of psychological aspects may occur.

Periprosthetic shoulder infection management: one-stage should be the way: a systematic review and meta-analysis.

BACKGROUND: There is still no consensus among surgeons on whether to perform a 1- or 2-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection, and other clinical complications in order to discuss which is the best strategy for treating periprosthetic joint infection after shoulder arthroplasty. METHODS: Upon research using the PubMed, Scopus, and Web of Science databases, in November 2022, studies that presented 1- or 2-stage surgical revision as a treatment for periprosthetic joint infection after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) score. Reinfection and complication rates were extracted, and pooled estimates were calculated using the random-effect model. RESULTS: After careful screening, 44 studies were included, 5 reporting on 1-stage and 30 on 2-stage revisions and 9 assessing both strategies. A total of 185 shoulders were reported in 1-stage revision studies, whereas 526 shoulders were reported in 2-stage revision studies. The overall pooled random-effects reinfection rate was 6.68% (95% confidence interval [CI]: 3.76-10.13), with low heterogeneity (I2 = 28%, P = .03). One-stage revision showed a reinfection rate of 1.14% (95% CI: 0.00-4.88), whereas 2-stage revision analysis revealed a reinfection rate of 8.81% (95% CI: 4.96-13.33). There were significant statistical differences between 1- and 2-stage reinfection rates (P = .04). The overall pooled rate for other clinical complications was 16.76% (95% CI: 9.49-25.15), with high heterogeneity (I2 = 70%, P < .01). One-stage revision had a complication rate of 6.11% (95% CI: 1.58-12.39), whereas the 2-stage revision complication rate was 21.26% (95% CI: 11.51-32.54). This difference was statistically significant (P = .03). CONCLUSIONS: This is the first systematic review and meta-analysis showing significant statistical differences between 1- and 2-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, 1-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.

Assessment of quality of life and psychological repercussions in women with endometriosis according to pain intensity.

The objective is to evaluate quality of life, anxiety, and depression in women with endometriosis, and to correlate these parameters with pain intensity. This multicenter cross-sectional study was conducted on 102 women with endometriosis from 2017 to 2020. The women were divided into two groups according to the pain intensity: group 1 (severe pain, 62 women) and group 2 (mild/moderate pain, 40 women). The Endometriosis Health Profile Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory were used to assess quality of life and levels of anxiety and depression, respectively. In both groups, mean age and mean body mass index were similar (p˃ 0.5). Most women had deep endometriosis and were on treatment, but group 2 had a longer treatment time (p = 0.044). Group 1 exhibited more depression and anxiety than group 2 (17.1 ± 9.98 vs. 11.15 ± 9.25, p = 0.003 and 23.71 ± 12.92 vs 12.58 ± 10.53, p = 0.001, respectively). Women with high pain had a significantly worse quality of life than those with low pain (48.88 ± 16.02 vs. 23.32 ± 15.93, p < 0.001). Women with endometriosis and high pain intensity have a worse quality of life, and more severe levels of anxiety and depression.

Prediction of heavy metals in polluted mangrove soils in Brazil with the highest reported levels of mercury using near-infrared spectroscopy.

Infrared reflectance spectroscopy has demonstrated potential as a tool for monitoring and preventing contamination in different environments. The objective of this study was to evaluate the usage of near-infrared spectroscopy for predicting heavy-metal contamination in mangrove soils from the Botafogo River estuary located in Pernambuco State, Northeastern Brazil. These soils exhibit the highest mercury (Hg) levels ever reported for Brazilian mangrove soils. Sixty-one samples (obtained at depths ranging from 0 to 5 cm) were collected and measured using near-infrared (1000-2500 nm) reflectance spectroscopy. Preprocessing methods were applied, and partial least squares regression was used to build prediction models for attributes such as clay content, soil organic matter (SOM), pH, Eh, and concentrations of Cr, Cu, Hg, Ni, Pb, and Zn. The models were evaluated using root mean squared error (RMSE), the adjusted coefficient of determination (R2adj), bias, the ratio of performance to interquartile distance (RPIQ), and Lin's concordance correlation coefficient (CCC). The best outcomes were noted for concentrations of Cr, Cu, Hg, Ni, and Pb (RPIQ > 2.5 and R2adj > 0.80); second-best outcomes were found for Zn and SOM (RPIQ > 1.5 and R2adj > 0.70). Clay content, pH and Eh exhibited the poorest outcomes (RPIQ < 1.5). The importance of spectral preprocessing is highlighted, notably with Savitzky-Golay derivatives and Multiplicative Scatter Corrections, which boosted performance for most of the variables. Near-infrared spectroscopy can be efficiently used to predict Cr, Cu, Hg, Ni, Pb and SOM and represents a technique complementary to traditional analyses.

Infection by Moniliophthora perniciosa reprograms tomato Micro-Tom physiology, establishes a sink, and increases secondary cell wall synthesis.

Witches' broom disease of cacao is caused by the pathogenic fungus Moniliophthora perniciosa. By using tomato (Solanum lycopersicum) cultivar Micro-Tom (MT) as a model system, we investigated the physiological and metabolic consequences of M. perniciosa infection to determine whether symptoms result from sink establishment during infection. Infection of MT by M. perniciosa caused reductions in root biomass and fruit yield, a decrease in leaf gas exchange, and down-regulation of photosynthesis-related genes. The total leaf area and water potential decreased, while ABA levels, water conductance/conductivity, and ABA-related gene expression increased. Genes related to sugar metabolism and those involved in secondary cell wall deposition were up-regulated upon infection, and the concentrations of sugars, fumarate, and amino acids increased. 14C-glucose was mobilized towards infected MT stems, but not in inoculated stems of the MT line overexpressing CYTOKININ OXIDASE-2 (35S::AtCKX2), suggesting a role for cytokinin in establishing a sugar sink. The up-regulation of genes involved in cell wall deposition and phenylpropanoid metabolism in infected MT, but not in 35S::AtCKX2 plants, suggests establishment of a cytokinin-mediated sink that promotes tissue overgrowth with an increase in lignin. Possibly, M. perniciosa could benefit from the accumulation of secondary cell walls during its saprotrophic phase of infection.

Searching for biomarkers of early detection of 2,4-D effects in a native tree species from the Brazilian Cerrado biome.

Biodiversity in the Brazilian Cerrado biome has been declining sharply with the continued expansion of agriculture and the excessive use of herbicides. Thus, the aim of this study was to evaluate the morphophysiological and biochemical responses in Dipteryx alata plants to various doses of the herbicide 2,4-D. Specific biomarkers that characterize the phytoindicator potential of this species were determined. Gas exchange, chlorophyll a fluorescence, photosynthetic pigments, and the activities of antioxidant enzymes and cellulase were performed after 24, 96 and/or 396 hours after 2,4-D application (HAA). The herbicide caused higher antioxidant enzymatic activity 24 HAA and damage to the photosynthetic machinery after 96 HAA. Reduction in gas exchange, chlorophyll content, and photochemical traits were observed. Increased respiratory rates, non-photochemical quenching, and carotenoid concentrations in 2,4-D-treated plants were important mechanisms in the defense against the excess energy absorbed. Furthermore, the absence of leaf symptoms suggested tolerance of D. alata to 2,4-D. Nevertheless, changes in the photosynthetic and biochemical metabolism of D. alata are useful as early indicators of herbicide contamination, especially in the absence of visual symptoms. These results are important for early monitoring of plants in conserved areas and for preventing damage to sensitive species.

Biochemical and physiological impacts of zinc sulphate, potassium phosphite and hydrogen sulphide in mitigating stress conditions in soybean.

Soybean is the most widely grown oilseed in the world. It is an important source of protein and oil which are derived from its seeds. Drought stress is a major constraint to soybean yields. Finding alternative methods to mitigate the water stress for soybean is useful to maintain adequate crop yields. The aim of this study was to evaluate the morpho-physiological, biochemical and metabolic changes in soybean plants in two ontogenetic stages, under exposure to water deficit and treatment with zinc sulphate (ZS), potassium phosphite (PP) or hydrogen sulphide (HS). We carried out two independent experiments in the V4 and R1 development stages consisting of the following treatments: well-watered control (WW, 100% maximum water holding capacity, MWHC), water deficit (WD, 50% MWHC), PP + WW, PP + WD, HS + WW, HS + WD, ZS + WW and ZS + WD. The experimental design consisted of randomized blocks with eight treatments with five replicates. Morphological, physiological and metabolic analyses were performed 8 days after the start of the treatments for both experiments. We identified two tolerance mechanisms acting in response to compound application during water stress: the first involved the upregulation of antioxidant enzyme activity and the second involved the accumulation of soluble sugars, free amino acids and proline to facilitate osmotic adjustment. Both mechanisms are related to the maintenance of the photosynthetic parameters and cell membrane integrity. This report suggests the potential agricultural use of these compounds to mitigate drought effects in soybean plants.

Dipteryx alata, a tree native to the Brazilian Cerrado, is sensitive to the herbicide nicosulfuron.

The expansion of land use for agricultural interests and the excessive use of herbicides are among the causes of biodiversity losses in the Brazilian Cerrado biome. Therefore, we aimed to test the hypothesis that Dipteryx alata Vogel, a common species in this biome, is sensitive to nicosulfuron because of its high phytotoxicity. We evaluated physiological, biochemical and morphological responses in D. alata plants exposed to increasing doses of the herbicide. Young plants were transplanted to 10 L pots containing substrate composed of soil and sand (2:1) after fertilization. After an acclimation period, the following doses of nicosulfuron were applied: 0 (control), 6, 12, 24, 48, and 60 g a.e. ha-1. The experiment was conducted in a randomized block design factorial scheme with six doses of nicosulfuron, three evaluation times, and five replicates per treatment. The effects of the herbicide were assessed by measuring gas exchange, chlorophyll a fluorescence, photosynthetic pigments, membrane permeability, antioxidant enzymes and acetolactate synthase. Nicosulfuron altered the photosynthetic machinery and enzymatic metabolism of D. alata. Reductions in physiological traits, increased catalase and ascorbate peroxidase activities, enhanced malondialdehyde concentrations rate of electrolyte leakage and decreased acetolactate synthase activity in response to nicosulfuron all suggest that D. alata is sensitive to this herbicide.

Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve.

BACKGROUND: A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team's initial learning period. METHODS: The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients' demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment. RESULTS: Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient's order number (r = - 0.539, p = 0.002). CONCLUSIONS: In our initial experience, MIDLIF showed to be effective in significantly improving the patients' functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.